Surgery can often cure long-term ulcerative colitis (UC), but it's not for everyone. Your doctor may suggest an operation if your UC is severe and you don't get enough help from other treatments, like medicines and changes in your diet. It could also be an option to help you prevent colon cancer.
There are two procedures. Both are major surgery on your digestive system. Get to know the details of each operation, and talk with your doctor about which one they recommend for you.
What it is. This procedure is also called IPAA (ileal pouch-anal anastomosis). Your surgeon removes the part of your bowel that's causing trouble, including your colon and rectum.
They'll use the end of your small intestine, called the ileum, to make a pouch inside your body that collects waste. Then they'll connect the pouch to your anus.
What are the side effects? The pouch can become irritated or inflamed, which is called pouchitis.
That’s the most common complication of J-pouch surgery, affecting about half of people. It can bring on symptoms like:
- Belly cramps
- Needing to poop more
- Joint pain
Antibiotics usually take care of the problem.
In some cases, J-pouch surgery can affect you in the bedroom. The operation could cause nerve damage that keeps you from getting an erection. Also, scar tissue could form around your ovaries and fallopian tubes, and lead to infertility.
J-pouch surgery can also raise your chances for complications like:
- Leaking in the colon. This can cause an infection. It can also cause a fistula, a small tunnel that starts inside your anus and leads to an opening on your skin around the anus.
- A serious infection called pelvic sepsis
- Pouch bleeding
- Blockages in your small intestine
- An infection in the part of the rectum left that’s known as the cuff
Talk to your doctor as soon as you notice any side effects. Ask them to recommend treatments that could help.
What to expect after the surgery. Because muscles around your anus aren't affected, you'll eventually be able to get rid of food waste the usual way, on the toilet.
At first, you'll need to wear a bag outside your body over a stoma. That’s a temporary surgical hole in your belly connected to your intestine. Solid waste leaves your body through the stoma and into the bag while your new internal pouch heals.
You'll still go to the bathroom often, but probably not as much as before the operation. In time, you may go even less frequently.
You may find that you can eat more foods than before you had the surgery, or you may feel better with your familiar foods. Try items one at a time to see how you feel. And don't eat within 3-4 hours of bedtime.
Give your recovery some time. Most people eventually get back to all of their usual activities. In the meantime, if you find that you tire out faster than usual, remember that you're healing from the operation. You will need a second surgery 8 to 12 weeks later to reverse the temporary ileostomy and reconnect your small intestine.
Your doctor can let you know about any limits you should have during your recovery. For instance, women who get the surgery should avoid sex for 6 weeks.
What it is. The surgeon removes your colon, rectum, and anus. This operation reroutes part of your digestive system so food waste goes from your small intestine straight out of your body through a hole, or stoma. It collects in an external pouch, or bag, that's connected to the outside of your lower belly. You change it when it gets full.
Your ileostomy may be permanent, or you might get it as a temporary measure before you get a J-pouch.
What are the side effects? As with any operation, there is a chance of infection.
Some other risks linked to an ileostomy are:
- Bleeding inside your small intestine or from your stoma
- Infection around your stoma
- Damage to organs near the surgery area
- Trouble absorbing enough nutrients from food
- Blockage -- some possible signs of this are no waste material comes out of your stoma for 4 to 6 hours, along with cramps or nausea
- Stoma juts out more than usual or pulls back farther inside your body
Talk to your doctor right away about any side effects you notice. Ask what treatments can help.
What to expect afterward. You should be able to go back to many of your daily activities in about 4 to 6 weeks. You may need more time before you can do things that are physically hard, like heavy lifting.
You can wear your regular clothes and even shower with the pouch on. It shouldn't show under your clothes or affect how you dress, but you might want to keep tight belts off of the stoma. If the bag is on securely, no one should smell any odors.
It will probably take time to adjust to living with the stoma and the ileostomy system. But you should get used to emptying the pouch with a little practice.
When you eat:
- Chew your food well.
- You may need to limit fiber, such as popcorn, foods with seeds, nuts, and raw veggies.
- Avoid gassy foods such as soda and beans.
You can feel confident about being back in your regular routine. Once you've healed, you can do everything you did before the operation -- go to work, play sports, have sex. But it is an adjustment, so talk to your doctor about how you can handle this change.